Estimating Heterogeneous Effects of a Policy Intervention across Organizations when Organization Affiliation is Missing for the Control Group: Application to the Evaluation of Accountable Care Organizations.
Estimating Heterogeneous Effects of a Policy Intervention across Organizations when Organization Affiliation is Missing for the Control Group: Application to the Evaluation of Accountable Care Organizations.
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当控制组的组织归属缺失时，估计跨组织的政策干预的异质性影响：应用于对责任关怀组织的评估。
DOI：
10.1007/s10742-020-00230-8
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发表时间：
2021-03
影响因子：
1.5
通讯作者：
O'Malley AJ
中科院分区：
文献类型：
--
作者：
Chen G;Lewis VA;Gottlieb D;O'Malley AJ
责任护理组织（ACO）于21世纪初首次引入，旨在降低医疗成本，同时提高护理质量，已成为美国最重要的协调护理技术之一。在这项研究中，我们使用2009-2014年的医疗保险按服务收费索赔数据来估计医疗保险ACO计划对医院转诊地区（HRR）和提供者群体的住院率的异质性影响。为了进行我们的分析，差异中的差异（DID）研究的模型以多种方式进行了修饰，以解释使用现有模型无法解释的数据的复杂性和复杂性。特别值得注意的是，我们提出了一个高斯混合模型来解释无法观察的实践组隶属关系的医生，如果他们工作的组织没有成为ACO，这是需要确保适当的分区的变化在不同的单位。结果表明，ACO计划降低了再入院率，ACO计划可能降低了再入院率的异质性，并且加入ACO的效果在不同的医疗群体中差异很大。
First introduced in early 2000s, the accountable care organization (ACO) is designed to lower health care costs while improving quality of care and has become one of the most important coordinated care technologies in the United States. In this research, we use the Medicare fee-for-service claims data from 2009-2014 to estimate the heterogeneous effects of Medicare ACO programs on hospital admissions across hospital referral regions (HRRs) and provider groups. To conduct our analysis, a model for a difference-in-difference (DID) study is embellished in multiple ways to account for intricacies and complexity with the data not able to be accounted for using existing models. Of particular note, we propose a Gaussian mixture model to account for the inability to observe the practice group affiliation of physicians if the organization they worked for did not become an ACO, which is needed to ensure appropriate partitioning of variation across the different units. The results suggest that the ACO programs reduced the rate of readmission to hospital, that the ACO program may have reduced heterogeneity in readmission rates, and that the effect of joining an ACO varied considerably across medical groups.
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影响因子：
2
作者：
Fraley, C;Raftery, AE
通讯作者：
Raftery, AE
影响因子：
4.2
作者：
BRONSTEIN, JM;MORRISEY, MA
通讯作者：
MORRISEY, MA
影响因子：
1.8
作者：
Biernacki, Christophe;Celeux, Gilles;Langrognet, Florent
通讯作者：
Langrognet, Florent
影响因子：
2
作者：
FOWLKES, EB;GNANADESIKAN, R;KETTENRING, JR
通讯作者：
KETTENRING, JR
影响因子：
8
作者：
CELEUX, G;GOVAERT, G
通讯作者：
GOVAERT, G